Purpose: To analyze the prevalence and resistance rates of bacterial agents causing urinary tract infections (UTIs) in Aseer, Saudi Arabia (2013–2016). Patients and Methods: This was a 4-year (2013–2016) retrospective study undertaken in Aseer Central Hospital, Saudi Arabia. A total of 49,779 urine and other UT specimens obtained from patients suspected of having a UTI were analyzed. Urine specimens were inoculated onto cystine lactose electrolyte deficient agar following standard procedures. Cultures showing significant bacteriuria were subjected to identification and sensitivity testing using VITEK 2 system. Data of patients and uropathogens were assembled, checked, and analyzed using SPSS software. Results: Culture positive samples were 49,779 (59.9% males, 40.1% females; P = 0.000). Year trend showed significant variations (P = 0.000) and the forecast trend line hypothesized a clear rise. Age groups 70–79 years were the most vulnerable group (22.3%). Gram-negative bacilli were 91.8% and the major species were Escherichia coli - 39.7%, Klebsiella pneumoniae - 15.8%; Pseudomonas aeruginosa - 13.8%, Proteus mirabilis - 10.6%, and Acinetobacter baumannii - 5%. Antimicrobials with high sensitivity rate were linezolid (99.1%), daptomycin (89.3%), vancomycin (86.7%), teicoplanin (85.5%), ertapenem (85.1%), fosfomycin (82.1%), and tigecycline (80.2%). High resistant rates to uropathogens were encountered with cephalothin (89.8%), nalidixic acid (86.7%), and ampicillin (81.9%). Conclusions: The majority of uropathogens were resistant to antibiotics commonly used in clinical practice. Linezolid, daptomycin, and vancomycin showed the lowest resistance to all uropathogens; this can be revised for empirical treatment of UTIs. Continuous surveillance of uropathogens and their susceptibility is important.

Context: Management of urinary tract infections (UTIs) is caused by antibiotic resistance uropathogens. Aim: This study aimed to determine the important uropathogens and their resistance to first-line urinary tract antimicrobial agents. Settings and Design: The region of Aseer, Southern Saudi Arabia, between 2013 and 2016. Materials and Methods: A total of 1506 isolates were recovered from the urine samples of patients that were identified and tested against nine first-line UTI antimicrobial agents. Laboratory analysis was done as per the standard methods. Confirmation of bacterial identity and antimicrobial susceptibility assay was achieved by the VITEK 2 automated system. Statistical Analysis Used: Statistical Package for the Social Sciences software version 21.0 was used for the statistical analysis. Results: The dominant uropathogens were Escherichia coli (E. coli) 507 (33.7%); Klebsiella pneumoniae (K. pneumoniae), 229 (15.21%); Pseudomonas aeruginosa, 153 (10.2%); Acinetobacter baumannii, 80 (5.3%); Enterococcus faecalis, 71 (4.7%); and Proteus mirabilis, 61 (4.1%). Of all culture-positive uropathogens, 51.5% were resistant to the 39 agents, whereas 48.5% were sensitive (P = 0.7969). Regarding the susceptibility to the first-line agent, the most effective against the dominant (in vitro) agents against E. coli were fosfomycin and nitrofurantoin (93.5%) and (85.4%), respectively. Whereas those worked well against K. pneumoniae were cefoxitin (57.1). Conclusions: The present study recommends the use of fosfomycin, cefoxitin, nitrofurantoin, and amoxicillin/clavulanate as the first choice UTIs treatment given their relatively high in vitro activity against major uropathogens. Knowledge of the bacterial species and their antimicrobial sensitivity patterns are always necessary to serve as a base for selecting the empirical treatment of UTIs as resistance rates vary geographically and with time.

Background: Neurosurgery is considered one of the most admired surgical specializations. Still, as evidenced by observations over the years, it is not amongst the top choices of medical students in Saudi Arabia. This study will help in understanding the perception and attitudes of medical students and interns toward the neurosurgery specialization, which will aid in developing strategies to increase the interest of undergraduates in neurosurgery specialization and bridge the human resource gap in this vital specialty. Objectives: This study aimed to assess perceptions, attitudes, and gender differences of medical students and interns toward neurosurgery. The influence of demographic factors on perceptions of neurosurgery of interns and senior medical students in Saudi Arabia was also investigated. Methodology: We conducted a cross-sectional study on a convenience sample of medical students (clinical years) and interns studying in different colleges of medicine in Saudi Arabia. A total of 1014 responses were included in this study (518 males and 496 females). The questionnaire comprised of two parts: the first part carried general descriptive questions, while the second part had 24-item Likert scale-based questions. Results: Around 40% of medical students and 26% of interns agreed or strongly agreed to the statement ‘I would consider a career in neurosurgery. Around 70% of both interns and students agreed or strongly agreed with the statement ‘Huge prestige is attached to neurosurgery’. The responses to the statement ‘Neurosurgery is a male specialty’ was significantly different between genders, as 36.5% of the male respondents agreed or strongly agreed with the statement while just 12.5% of the females responded likewise (p = 0.000). Only 23% of participants reported having completed a rotation in neurosurgery. About 44.7% of respondents were interested in taking an elective rotation in neurosurgery, while the remaining respondents (55.3%) responded with a negative answer. Only 23% of participants had completed an undergraduate rotation in neurosurgery. More males (65.3%) agreed or strongly agreed with the statement ‘Work as a neurosurgery specialist can impede family life as compared to females (57.5%), which was highly significant (p = 0.000). More medical students (45.1%) responded in the agreement or strong agreement in response to the statement’ Neurosurgery should be a compulsory rotation during internship’ as compared to interns (25.8%). Around 65% of the respondents agreed or strongly agreed that teachers/seniors have a great influence on students’ specialization choices. Around 67% of the respondents foresaw a purely clinical role for themselves after graduation, while 17% were interested in a clinical–academician role. Conclusions: The study reflected a generally positive attitude towards neurosurgery amongst medical students and interns. Interest in neurosurgery as a specialization can be strengthened by enhancing the exposure of students and interns to the specialty. Teachers and seniors can be useful influencers to motivate students to consider neurosurgery specialization.

Introduction: Although the Kaposi sarcoma (KS) is one of the AIDS defining entity and seen in almost one third of HIV infected patients with low CD4 cell counts, it is not uncommon in HIV seronegative persons, but genital KS is rare, particularly in people without risk factors for HIV infection. Isolated penile KS is an unusual manifestation, especially as solitary nodule with ulceration, in HIV seronegative patient. Case presentation: We report such a case of Kaposi sarcoma showing HHV-8 positivity in an elderly male Arabian patient with a delay in prompt diagnosis, but treated successfully with 3 3 years follow-up after limited local surgical excision. Conclusion: The general practitioners, venereologists and urologists should think of KS as a possibility in such lesion and consider early biopsy.

BACKGROUND Varicocele embolization, a minimally invasive treatment for symptomatic varicoceles, carries a rare risk of complications like ureteral obstruction and hydronephrosis. This case report documents such a case to raise awareness of these potential complications and showcase minimally invasive surgical management as a successful solution. CASE SUMMARY A 35-year-old male presented with flank pain and hematuria following varicocele embolization. Imaging confirmed left ureteral obstruction and hydronephrosis. Laparoscopic ureterolysis successfully removed the embolization coil and repaired the ureter, resolving the patient's symptoms. Follow-up at six months and two years showed sustained improvement. CONCLUSION Minimally invasive surgery offers an effective treatment option for rare complications like ureteral obstruction arising from varicocele embolization.